Search

Motivation: In the three years before 2023, we have seen multiple parallel crises—from climate emergencies to economic instability, dramatic increases in costs of living, and political insecurities. Looming larger than the risks is the resultant uncertainty. Development agents, including governments, are historically unprepared for managing converging crisis. When risks are analysed and governed in narrow ways, the historically oppressed and excluded continue to carry the brunt of impact. Purpose: This article reflects on the question: How can institutions, including governments, become more anticipatory against this backdrop, to ensure that their policy and investment choices do not leave anyone behind due to lack of preparedness? Approach and methods: It draws insights from the United Nations Development Programme (UNDP) in Asia and the Pacific's efforts since 2020 to apply more future‐fit planning and programming, recognizing that foresight is not an end in itself, but a mechanism for shaping more anticipatory institutions. It is based on qualitative learning synthesized from over three years of work to establish new systems, capabilities and processes for UNDP and its partners to engage in anticipatory risk and planning. Findings: Practices rooted in strategic foresight and anticipation can support institutions to incorporate long‐term thinking in planning and analysis, but their translation into development decisions and investments requires shifts in perspectives and risk appetite. Historically, strategic foresight has not been mainstreamed within international organizations and governments owing to: failing to embed anticipation into core systems and processes; giving more attention to tools and building skills than to the demand for alternative decision‐making models and to risk tolerance; relying overly on external support and static models; insufficiently attending to organizational culture and relational drivers of thinking and action. Policy implications: We suggest four interconnected levers to help sustain impact and equity when bringing anticipatory approaches into policy processes: ensure design elasticity to encourage local, context‐specific models of anticipatory decision‐making; build anticipatory systems as a base to understand future risks, harms, and correlating impacts; interrogate what counts as legitimate and relevant evidence for policy decisions; cultivate imagination as an act of inquiry. [ABSTRACT FROM AUTHOR]

Objective: The aim of the studywas to evaluate the influence of repeated sprints on kinematic performance and propulsion variables during the acceleration and constant peak velocity phases in wheelchair rugby players classified as defensive (low point in defensive [LP-D]) or offensive players (high point in offensive [HP-O]). Design: Twenty-two players (13 LP-D and 9 HP-O) performed 6° 20-m repeated sprint field tests. We calculated peak wheelchair velocities, propulsion phase times, deceleration phase times, cycle times, and left-right velocity asymmetry of the best and last sprints during the acceleration and constant peak velocity phases, the rate of decline in performance variables between the best and the last sprint and a fatigue index. Results: Peak velocities during the acceleration and constant peak velocity phases and mean velocity over thewhole sprint were significantly higher during the best than last sprint. Peak velocities were higher during the acceleration and constant peak velocity phases for the best and last sprint for HP-O. The rate of decline in peak velocity during the constant peak velocity phasewas higher for LP-D. Fatigue index and rate of decline in velocities and sprint time were higher for LP-D. Conclusions: Performance variables and the rate of decline in performance variables depended on functional capacity and wheelchair type. [ABSTRACT FROM AUTHOR]

In this paper, regime complexes are conceptualized as dynamic networks constituted by relations between international organizations (IOs). We introduce "IO positioning" as a conceptual lens for studying patterns and shifts in IO networks resulting from negotiations between IOs over their distinctiveness and social membership in complex organizational fields. We suggest that IO positioning has two constitutive effects. First, on the level of individual IOs, positioning affects IO identities within the field as these are (re)negotiated in relations with other organizations. Secondly, the positioning practices of IOs have constitutive effects on the contours of entire policy fields too; they form and shift the boundaries of regime complexes. Empirically, the paper examines the utility of our approach by analyzing the history, dynamics, and positioning effects of interorganizational relations between eight IOs in global health governance—an area of international cooperation that is commonly portrayed as exceptionally fragmented, complex, and densely populated. Examining relations between our eight IOs, we provide network analytical longitudinal data of in- and out-reporting by IOs derived from IOs' annual reports between 1970 and 2017. We triangulate our network analysis with data derived from semi-structured interviews with health IO professionals. [ABSTRACT FROM AUTHOR]

Can international organizations improve natural resource governance? The International Monetary Fund (IMF) is most noted for its role in crisis lending, where it can wield the "teeth" of loan suspensions to push for reforms. But IMF officials also spend a large amount of time conducting routine surveillance through Article IV consultations, which assess a country's economic developments and provide non-binding recommendations. Do governments follow this "toothless" advice? To answer this question, we examine the content of all Article IV staff appraisals published between 2004 and 2019. Using text analysis and a difference-in-differences estimator, we find that resource-rich developing countries are more likely to adopt legislation reforming the oil, gas, and mining sectors in the wake of an Article IV appraisal that extensively discusses the natural resource sector and recommends natural resource governance reforms. Our results suggest that technocratic advice—a tool often overlooked in international organization scholarship—can lead to the adoption of policies that help ameliorate the resource curse. [ABSTRACT FROM AUTHOR]

Public views on international organizations (IOs) have become a matter of central concern. While actors in world politics increasingly try to legitimize or delegitimize IOs, scholars have begun investigating such phenomena systematically. This paper provides the most comprehensive IO (de)legitimation study to date. Building on cueing theory, and considering input as well as output legitimacy, I examine the isolated and combined effects of delegitimation and self-legitimation on public perceptions of IOs. I concentrate on government criticism and citizen protests as two salient practices of delegitimation. In investigating self-legitimation, I focus on IOs' public statements and institutional reforms. I study public opinion on the UN, World Bank, and WHO, as IOs of different functional scopes and levels of salience. In 2021, I conducted survey experiments on more than 32,000 citizens in ten countries worldwide (Australia, Canada, Colombia, Egypt, France, Hungary, Indonesia, Kenya, South Korea, and Turkey) – weighted by age, gender, region, and education. My main findings are: Delegitimation by governments and citizen protests has some limited effectiveness, depending on the IO in question. While IO self-legitimization statements and reforms in themselves do not boost public support for IOs, they are generally effective at neutralizing delegitimation attempts by governments and citizen protests. [ABSTRACT FROM AUTHOR]

While International Relations scholarship has increasingly addressed questions of race, the literature on international organizations (IOs) has been slower to do so. In particular, it has neglected how race functions within IO workforces. Building on sociological theories of racialized organizations, we develop the concept of racialized IOs. Like domestic organizations, racialized IOs are characterized by enhanced or inhibited agency of racial groups, racialized distribution of resources, credentialing of whiteness, and decoupling of formal rules and informal practices along racial lines. However, there are also two important differences. First, since IOs rely on member states for resources, their secretariats need to accommodate powerful white-majority countries (macro-level pressures). Second, since IO workforces are diverse, their employees may bring a range of racial stereotypes that exist in their societies into their professional practice (micro-level pressures). Using the case of UN peacekeeping, we demonstrate how the four features of racialized organizations operate in light of these macro- and micro-level pressures. We show that locally hired peacekeeping staff face constraints on exercising agency; that non-white peacekeepers perform more dangerous jobs than their white counterparts; that whiteness serves as a proxy for desirable skills while non-white peacekeepers' knowledge is devalued; and that peacekeepers from white-majority countries receive special treatment or deviate from UN-wide procedures. [ABSTRACT FROM AUTHOR]

BPA has demonstrated enormous multisystem and multi-organ toxicity shown mainly in animal models. Meanwhile, the effects of its exposure in humans still require years of observation, research, and answers to many questions. Even minimal and short-term exposure contributes to disorders or various types of dysfunction. It is released directly or indirectly into the environment at every stage of the product life cycle, demonstrating its ease of penetration into the body. The ubiquity and general prevalence of BPA influenced the main objective of the study, which was to assess the toxicity and health effects of BPA and its derivatives based on the available literature. In addition, the guidelines of various international institutions or regions of the world in terms of its reduction in individual products were checked. Bisphenol A is the most widely known chemical and perhaps even the most studied by virtually all international or national organizations, but nonetheless, it is still controversial. In general, the level of BPA biomonitoring is still too high and poses a potential threat to public health. It is beginning to be widely argued that future toxicity studies should focus on molecular biology and the assessment of human exposure to BPA, as well as its substitutes. The effects of its exposure still require years of observation, extensive research, and answers to many questions. It is necessary to continue to deepen the knowledge and interest of many organizations, companies, and consumers around the world in order to make rational purchases as well as future choices, not only consumer ones. [ABSTRACT FROM AUTHOR]

Background: The organization of healthcare for people with intellectual and developmental disabilities (IDD) varies across countries. Each country has developed unique practices embedded in their historical and organizational context. Understanding and sharing these practices across borders facilitates mutual understanding about healthcare needs of people with IDD and facilitates the adoption of effective strategies in other countries. Aim: To provide a synthesis across the country‐specific papers in the JPPID special edition and thereby identify underlying trends, challenges, and best practices in healthcare for people with IDD. Methods: The papers in this special edition, which describe the organization of healthcare for people with IDD in 13 countries, were qualitatively analyzed using thematic content analysis, focusing on general characteristics, history, and context, organization of healthcare for people with IDD, challenges, and best practices. Results: Each paper described a specific national history of evolution of healthcare for people with IDD, but our analysis showed that countries face similar challenges in healthcare for people with IDD. These challenges cover (1) access to healthcare, (2) quality of healthcare, (3) implementation, and (4) visibility of people with IDD. Consequently, people with IDD continue to face significant health disparities. Several best practices have been developed, ranging from making mainstream healthcare more accessible and suitable to providing specialized services, and advocating and raising awareness. Conclusions: This synthesis is the first paper to include perspectives on healthcare for people with IDD across 13 countries. We identified that, despite differences in context, countries face similar challenges in improving healthcare for people with IDD. International collaboration and networking can provide essential tools in reducing health disparities that people with IDD face, starting with the challenges identified in this synthesis. This will require effort to especially include low‐ and middle‐income countries. [ABSTRACT FROM AUTHOR]

Although international organisations (IOs) are created by governments, their international public administrations (IPAs) have succeeded in ring-fencing their resources, and policymaking from direct intervention by member states. Research shows that international civil servants are best able to protect their autonomy when embedded in large and well-resourced IPAs. Staff in large IOs use their huge size, bureaucratic complexities, and different behavioural logics to protect their autonomy and thereby leave a 'bureaucratic footprint' in international affairs. Whereas the behavioural logics of large IPAs, mostly headquartered in the Global North, are reasonably well-documented, not much has been written on behavioural logics of international civil servants embedded in small secretariats. We seek to address the gap using the African Union Commission (AUC) staff. Drawing insights from organisational theory and mixed research methods, including the first ever comprehensive survey of AUC staff, the study finds that the AUC staff primarily evoke a departmental behavioural logic. In the absence of departmental logics, the preference of AUC staff is to take on supranational, transnational, and lastly intergovernmental persona. The reluctance of AUC staff to evoke intergovernmental logic is surprising given that the AUC is embedded in an intergovernmental governance architecture. [ABSTRACT FROM AUTHOR]

The 'High Representative' speaks on behalf of the European Union in international organizations since 2010. The motivation for this reform has been to strengthen the European Union's foreign policy representation. It can be expected that this empowerment of the High Representative has affected the content of official European Union speeches held at the United Nations. Did the reform lead to a more coherent and cohesive representation of European Union foreign policy at the United Nations? To answer this question, I analyze the content of all speeches held on behalf of the European Union in the United Nations General Assembly between 1993 and 2021. I find that European Union foreign policy priorities are more coherently and cohesively represented since the Lisbon reforms took effect. I argue that the empowerment of the 'High Representatives' and their diplomats caused this effect. Today, European Union representatives are less likely to follow global trends but set their own thematic priorities by focusing on the areas of disarmament, sustainable development, and international law. [ABSTRACT FROM AUTHOR]

Research is key to academic advancement in plastic surgery. However, access to publication opportunities may be inequitable as seen in other fields. We compared authorship trends of plastic surgery manuscripts that underwent single-blinded review (SBR) versus double-blinded review (DBR) to identify potential disparities in publication opportunities. Publications from two plastic surgery journals using SBR and two using DBR from September 2019 to September 2021 were evaluated. Name and institution of the article's first and senior author and journal's editor-in-chief (EIC) were recorded. Chi-squared and Fisher's exact analyses were used to compare author characteristics between SBR and DBR articles. Of 2500 manuscripts, 65.7% underwent SBR and 34.3% underwent DBR. SBR articles had higher percentages of women as first authors (31.9% versus 24.3%, P < 0.001) but lower percentages of first (50.7% versus 71.2%, P < 0.001) and senior (49.6% versus 70.3%, P < 0.001) authors from international institutions. First (26.0% versus 12.9%, P < 0.001) and senior (27.9% versus 18.0%, P = 0.007) authors of SBR articles tended to have more plastic surgery National Institutes of Health funding. Journals using SBR tended to have higher rates of authorship by EICs or authors sharing institutions with the EIC (P ≤ 0.005). While associated with greater female first authorship suggesting potential efforts toward gender equity in academia, SBR of plastic surgery articles tends to favor authors from institutions with higher National Institutes of Health funding and disadvantage authors from international or lower-resourced programs. Careful consideration of current peer-review proceedings may make publication opportunities more equitable. • Single-blinded reviewed plastic surgery articles had more female authorship. • Single-blinded reviewed plastic surgery articles had less international authorship. • Authors of single-blinded reviewed plastic surgery articles had more National Institutes of Health funding. • Journals using single-blinded review had greater authorship by editors-in-chief. [ABSTRACT FROM AUTHOR]

There is significant and growing interest in better understanding hierarchy in the international system, especially in relation to intergovernmental organizations (IGOs). Acknowledging the existence of hierarchy in a system implies that there are different social positions (higher/lower), but not why or how a specific differentiation came to be used, nor how it is structured, contested or resolved. This article is interested in contributing to these questions, particularly in the context of heterarchical settings (where more than one hierarchy is present), which is also not fully understood. It uses the first years of the International Labour Organization (ILO) as a springboard to reflect upon hierarchy within the so-called 'civilized' group of countries in the immediate aftermath of World War I. This IGO was the first to (1) introduce statistical data to rank countries, with criteria designed to 'objectively' gauge industrial power and (2) establish a geographic allocation of countries in its main decision-making body's structure. Non-European countries and non-great powers had critical roles in establishing these novel ways of dealing with hierarchies and their institutional design in IGOs. One hundred years later, these discussions still resonate with several ongoing cases of contestation in IGOs over 'fair' hierarchical structures. [ABSTRACT FROM AUTHOR]

The Oral Glucose Tolerance Test (OGTT) remains a gold standard for diagnosis of diabetes and prediabetes all over the world and also in India. The original OGTT was a five sample test which included fasting, 30, 60, 90, and 120 min. Later, the test was modified in the US to two sample test 0 and 120 min, i.e., fasting and 2 h after 75 g glucose and this has been in practice all over the world. Traditional diabetologists continue to measure some of the intermediate samples, particularly the 60 min or 1 h value which identifies individuals even before the fasting or 2 h value becomes abnormal. Thus, even before the stage of prediabetes when one has a normal fasting and 2 h value, a raised 1 h value above 155 mg/dl has been shown to predict who will progress to diabetes. A group of 22 international experts recently got together and the IDF Position Statement on the 1 h value was published which shows why the 1 h value in the OGTT should be reintroduced in the routine lab testing of OGTT. This article is an endorsement of the IDF Position Statement on the 1 h value. Introducing the 1 h value in the OGTT is particularly relevant to India which has one of the fastest conversions of prediabetes to diabetes and also a very rapid loss of beta cell function. Identifying early stages of intermediate hyperglycemia can help to prevent diabetes and also reverse the condition. [ABSTRACT FROM AUTHOR]

This paper proposes that the General Agreement on Tariffs and Trade (GATT) and its successor, the World Trade Organization (WTO), experienced a deepening/widening tradeoff: as their membership increased (greater width), their effectiveness in promoting trade between members/participants declined (lesser de facto depth). This proposition is tested using gravity models of bilateral trade, first separating the GATT and WTO, which are usually combined into a single variable, and then adding a width variable corresponding to each institution. The results show that (1) both regimes were the deepest, or the most trade effective, when they had the fewest member-states and (2) their trade effectiveness declined, eventually becoming statistically insignificant, as more countries joined. As a quantitative case study, this paper provides some of the first evidence consistent with a tradeoff between depth and width within international institutions. [ABSTRACT FROM AUTHOR]

The year 2016 is remembered globally for the adoption of the New York Declaration and its Comprehensive Refugee Response Framework (CRRF) as the new global refugee response model. In this regard, Ethiopia has been one of those African countries that have adopted the Declaration, made specific CRRF pledges and has become a CRRF pilot country. Such national policy move heralded the shift of refugee policy in Ethiopia in the post-2016 era. Nonetheless, compared to the focus accorded to refugees and the role of international institutions and donors, the role of African hosting states in the governance of refugees and how they navigate internal and external demands and adopt policies have been paid little scholarly attention. This study, therefore, aims to fill in this scholarly gap and contribute to the existing debate in the academic and policy circle on state response to refugees in the era of CRRF from the Global South perspective by providing an empirical insight into the nature, dynamics and shift of refugee policies in Ethiopia and the factors that contributed to this effect. [ABSTRACT FROM AUTHOR]

Simple Summary: Emerging endometrial cancer research allows for a better understanding of the natural progression of this disease. This, in turn, gives way to better strategies by which to identify and effectively treat endometrial cancer. The International Federation of Gynecology and Obstetrics (FIGO) uses this compendium of evolving research to establish and subsequently update a staging classification system for endometrial cancer. Imaging studies are crucial in the diagnosis of endometrial cancer, and with the most recent update to the FIGO endometrial cancer staging system, their role must be reviewed. The FIGO endometrial cancer staging system recently released updated guidance based on clinical evidence gathered after the previous version was published in 2009. Different imaging modalities are beneficial across various stages of endometrial cancer (EC) management. Additionally, ongoing research studies are aimed at improving imaging in EC. Gynecological cancer is a crucial element in the practice of a body radiologist. With a new staging system in place, it is important to address the role of radiology in the EC diagnostic pathway. This article is a comprehensive review of the changes made to the FIGO endometrial cancer staging system and the impact of imaging in the staging of this disease. [ABSTRACT FROM AUTHOR]

Over decades, research practitioners have highlighted how survivors of sexual abuse in childhood face strong forms of stigma including victim‐blaming, shame and social isolation. However, the data and evidence are disproportionately slanted towards the global North. Shifting the focus to the global South, this reflective piece draws on two substantial multicountry research projects to highlight the expectations and experiences of young survivors of child sexual exploitation and abuse (CSEA) in their quest for support. By applying a socio‐ecological analysis, it demonstrates how societal stigma—from both professionals and young people themselves—compounds the help‐seeking process. The findings support the well‐documented concept that disclosing sexual violence is an ongoing—not singular—process that depends on a series of interactions at the individual, interpersonal and institutional levels of the ecosystem. Building better trauma‐informed responses is likely to help; however, a focus only on services falls short, especially in countries where child protection systems struggle to thrive. A concurrent transformative shift in both social and gender norms across the ecosystem is essential to address the seemingly intractable challenges to child sexual exploitation and abuse prevention and response. [ABSTRACT FROM AUTHOR]

Multistakeholder partnerships (MSPs) in global environmental governance are either praised for their problem-solving capacities and inclusion of various societal actors or criticized for their limited accountability and corporate dominance. Despite the lively scholarly debate and the continued promotion of MSPs by international organizations and governments, knowledge about how environmental MSPs are perceived by the public is very limited. Understanding the sources of public support for MSPs is important, given its crucial role in MSPs' abilities to secure resources and achieve their goals. In this article, we evaluate whether and how institutional features of MSPs influence citizens' legitimacy beliefs. Building on previous studies, we theorize which institutional dimensions of MSPs matter for citizens' level of support. We conduct population-based survey experiments in Brazil, the United Kingdom, and the United States, encompassing more than 6,000 respondents. The results from the survey experiments have substantive implications for our understanding of the role of MSPs. [ABSTRACT FROM AUTHOR]

The article offers information on iCAN, the International Children's Advisory Network, highlighting its role as a global platform empowering the patient voice in healthcare. Topics include the organization's mission, structure, and impact, with a focus on youth-driven initiatives in pediatric healthcare.

Recent advances in artificial intelligence (AI), combined with a proliferation in use, have led to a newfound emphasis on strengthening the global governance of AI. In this article, we assess the prospects for stronger global AI governance and consider potential pathways forward. We map the nascent landscape of international regimes focused on AI governance and conclude that a governance deficit remains due to the inadequacy of existing initiatives, gaps in the landscape and difficulties reaching agreement over more appropriate mechanisms. First-order cooperation problems stemming from interstate competition and second-order cooperation problems from dysfunctional international institutions problematize overcoming current deficiencies in global AI governance. In light of these cooperation problems, we evaluate two pathways for strengthening global AI governance: (a) developing new centralized international AI institution(s); and (b) strengthening coordination between, and capacities of, existing institutions. We argue that strengthening the existing weak 'regime complex' of international institutions is the more politically legitimate and viable path forward. Improving coordination between, and capacities of, existing international institutions governing AI would support inclusive and mutually reinforcing policy change that can mitigate a range of risks associated with these technologies. As first steps for strengthening the weak AI regime complex, we recommend that the OECD is foregrounded as a centre of expert AI knowledge so that it can facilitate peer pressure among states and harmonization of policies. We also encourage scrutiny of different nodes in the regime complex to ensure that they are fulfilling appropriate functions based on their democratic mandates. [ABSTRACT FROM AUTHOR]

This article maps how Ukraine's international agency has been discursively constructed through juxtaposing and relating different insecurities triggered by the Russian full-scale invasion in 2022. How does Ukraine persuade its partners of the validity of its approach to these insecurities, what is the intentionality behind its strategy, and how do they contribute to the production of the Ukrainian agency? It argues that Ukraine's agency is developed in the context of the battlefield, and therefore becomes a heavy loaded security concept with a strong normative background. By addressing numerous insecurities in energy supply, environmental and nuclear hazards, and disruption of food transportation, Ukraine builds the strategic narrative of the war as an intrinsic part of European security governance. [ABSTRACT FROM AUTHOR]

The 70 recommendations summarize the current status of preoperative risk evaluation of adult patients prior to elective non-cardiothoracic surgery. Based on the joint publications of the German scientific societies for anesthesiology and intensive care medicine (DGAI), surgery (DGCH), and internal medicine (DGIM), which were first published in 2010 and updated in 2017, as well as the European guideline on preoperative cardiac risk evaluation published in 2022, a comprehensive re-evaluation of the recommendation takes place, taking into account new findings, the current literature, and current guidelines of international professional societies. The revised multidisciplinary recommendation is intended to facilitate a structured and common approach to the preoperative evaluation of patients. The aim is to ensure individualized preparation for the patient prior to surgery and thus to increase patient safety. Taking into account intervention- and patient-specific factors, which are indispensable in the preoperative risk evaluation, the perioperative risk for the patient should be minimized and safety increased. The recommendations for action are summarized under "General Principles (A)," "Advanced Diagnostics (B)," and the "Preoperative Management of Continuous Medication (C)." For the first time, a rating of the individual measures with regard to their clinical relevance has been given in the present recommendation. A joint and transparent agreement is intended to ensure a high level of patient orientation while avoiding unnecessary preliminary examinations, to shorten preoperative examination procedures, and ultimately to save costs. The joint recommendation of DGAI, DGCH and DGIM reflects the current state of knowledge as well as the opinion of experts. The recommendation does not replace the individualized decision between patient and physician about the best preoperative strategy and treatment. [ABSTRACT FROM AUTHOR]

This essay plays out a few ethics reasons we have to reconsider what’s really being marketed to us in some free offers that distract us from questions of ethical, cultural, and clinical importance, for example. Possible points of focus for bioethics as a field are related to antimicrobial resistance and stewardship. [ABSTRACT FROM AUTHOR]

In 2012, the World Federation for Medical Education (WFME) evaluated and formally recognized the first agency in its Recognition Programme (RP). The RP was developed to review accrediting authorities in response to a 2010 policy by the Educational Commission for Foreign Medical Graduates (ECFMG) to require international medical graduates (IMGs) seeking to practice in the U.S. to graduate from an appropriately accredited medical school. By the end of 2022, WFME had recognized 33 accrediting bodies and received applications from another 16, which accounted for over three-quarters of the world's medical schools. In 2023, WFME leadership changed hands, and the ECFMG will take its first steps toward implementing its Recognized Accreditation Policy. In this article, we look back at the genesis of the RP and describe its first decade as informed by the limited existing peer-reviewed literature and the emerging activities of accrediting agencies that could have significant implications for the quality of medical education internationally. The rapidly growing influence of WFME on medical education worldwide has largely occurred without significant awareness or scrutiny, and there is a need for the WFME to demonstrate greater transparency, proactively engage its stakeholders, and support research and evaluation. [ABSTRACT FROM AUTHOR]

International institutions strive to achieve their own objectives while operating within a complex network of interdependencies. These interdependencies create an extensive web of relationships that serve as potential pathways for broader institutional impacts. The actions taken by individual institutions, their mutual influences, and the pattern of connectivity collectively shape the overall performance of institutional complexes. Understanding the performance of these complexes is crucial, yet we currently lack a methodology to assess it. To address this gap, we have developed a conceptual framework that integrates three distinct areas of study on three different scales: institutional effectiveness, institutional interlinkages, and institutional networks. This framework enables us to consider what we call the latent net effectiveness, or collective problem-solving potential, of a group of interconnected institutions. To put this framework into practice, we have devised a heuristic model, drawing from the extensive literature on international environmental institutions. As an illustrative example, we have applied this model to a network of 378 multilateral environmental agreements with 810 known issue linkages. Our work underscores the relevance of considering the system-level properties of institutional complexes and emphasizes the need for timely network-based governance and policy interventions to enhance the overall effectiveness of institutional complexes. This article is part of the theme issue 'A complexity science approach to law and governance'. [ABSTRACT FROM AUTHOR]

Background Since publication of Duke criteria for infective endocarditis (IE) diagnosis, several modifications have been proposed. We aimed to evaluate the diagnostic performance of the Duke-ISCVID (International Society of Cardiovascular Infectious Diseases) 2023 criteria compared to prior versions from 2000 (Duke-Li 2000) and 2015 (Duke-ESC [European Society for Cardiology] 2015). Methods This study was conducted at 2 university hospitals between 2014 and 2022 among patients with suspected IE. A case was classified as IE (final IE diagnosis) by the Endocarditis Team. Sensitivity for each version of the Duke criteria was calculated among patients with confirmed IE based on pathological, surgical, and microbiological data. Specificity for each version of the Duke criteria was calculated among patients with suspected IE for whom IE diagnosis was ruled out. Results In total, 2132 episodes with suspected IE were included, of which 1101 (52%) had final IE diagnosis. Definite IE by pathologic criteria was found in 285 (13%), 285 (13%), and 345 (16%) patients using the Duke-Li 2000, Duke-ESC 2015, or the Duke-ISCVID 2023 criteria, respectively. IE was excluded by histopathology in 25 (1%) patients. The Duke-ISCVID 2023 clinical criteria showed a higher sensitivity (84%) compared to previous versions (70%). However, specificity of the new clinical criteria was lower (60%) compared to previous versions (74%). Conclusions The Duke-ISCVID 2023 criteria led to an increase in sensitivity compared to previous versions. Further studies are needed to evaluate items that could increase sensitivity by reducing the number of IE patients misclassified as possible, but without having detrimental effect on specificity of Duke criteria. [ABSTRACT FROM AUTHOR]

Background The 2023 Duke-ISCVID (International Society of Cardiovascular Infectious Diseases) classification is a new diagnostic tool for infective endocarditis, updating the 2000 modified Duke and the 2015 European Society for Cardiology (ESC) classifications. In comparison, its sensitivity is higher; however, its specificity remains to be evaluated and compared to that of the 2 other classifications in endocarditis suspected patients. Methods We retrospectively collected the characteristics of patients hospitalized in Bichat University's Hospital, Paris, in 2021, who had been evaluated for clinical suspicion of endocarditis, have had at least a transthoracic echocardiography, 2 pairs of blood cultures, 3-month follow-up and in whom endocarditis diagnosis was finally rejected. All patients were classified by 2000 modified Duke, 2015 ESC and 2023 Duke-ISCVID, as though the endocarditis diagnosis had not been rejected. Results In total, 130 patients' charts were analyzed. Mean age was 62 years, 84 (64.6%) were male, 39 (30.0%) had prosthetic cardiac valve or valve repair, 21 (16.2%) cardiac implanted electronic device, and 30 (23.1%) other cardiac conditions. Overall, 5, 2, and 5 patients were falsely classified as definite endocarditis with the 2000 modified Duke, 2015 ESC, and 2023 Duke-ISCVID classifications, respectively. The corresponding specificities were 96.2% (95% confidence interval [CI] [90.8%, 98.6%]), 98.5% (95% CI [93.9%, 99.7%]), and 96.2% (95% CI [90.8%, 98.6%]). The rates of possible endocarditis were of 38%, 35%, and 35% in the 3 classifications, respectively. Conclusions The 2023 Duke-ISCVID classification is highly specific for ruling out the diagnosis of definite infective endocarditis in patients who had been evaluated for IE. [ABSTRACT FROM AUTHOR]

Background The 2023 Duke–International Society of Cardiovascular Infectious Diseases (ISCVID) criteria for infective endocarditis (IE) were introduced to improve classification of IE for research and clinical purposes. External validation studies are required. Methods We studied consecutive patients with suspected IE referred to the IE team of Amsterdam University Medical Center (from October 2016 to March 2021). An international expert panel independently reviewed case summaries and assigned a final diagnosis of "IE" or "not IE," which served as the reference standard, to which the "definite" Duke-ISCVID classifications were compared. We also evaluated accuracy when excluding cardiac surgical and pathologic data ("clinical" criteria). Finally, we compared the 2023 Duke-ISCVID with the 2000 modified Duke criteria and the 2015 and 2023 European Society of Cardiology (ESC) criteria. Results A total of 595 consecutive patients with suspected IE were included: 399 (67%) were adjudicated as having IE; 111 (19%) had prosthetic valve IE, and 48 (8%) had a cardiac implantable electronic device IE. The 2023 Duke-ISCVID criteria were more sensitive than either the modified Duke or 2015 ESC criteria (84.2% vs 74.9% and 80%, respectively; P <.001) without significant loss of specificity. The 2023 Duke-ISCVID criteria were similarly sensitive but more specific than the 2023 ESC criteria (94% vs 82%; P <.001). The same pattern was seen for the clinical criteria (excluding surgical/pathologic results). New modifications in the 2023 Duke-ISCVID criteria related to "major microbiological" and "imaging" criteria had the most impact. Conclusions The 2023 Duke-ISCVID criteria represent a significant advance in the diagnostic classification of patients with suspected IE. [ABSTRACT FROM AUTHOR]

Background: Targeted marketing of menthol cigarettes in the US influences disparities in the prevalence of menthol smoking. There has been no analysis of sub-national data documenting differences in use across demographic subgroups. This study estimated trends in the prevalence of menthol use among adults who smoke in the nine US census divisions by sex, age, and race/ethnicity from 2002 to 2020. Methods: Data from 12 waves of the US ITC Survey were used to estimate the prevalence of menthol cigarette use across census divisions and demographic subgroups using multilevel regression and post-stratification (n = 12,020). Multilevel logistic regression was used to predict the prevalence of menthol cigarette use in 72 cross-classified groups of adults who smoke defined by sex, age, race/ethnicity, and socioeconomic status; division-level effects were fit with a random intercept. Predicted prevalence was weighted by the total number of adults who smoke in each cross-classified group and aggregated to divisions within demographic subgroup. Estimates were validated against the Tobacco Use Supplement to the Current Population Survey (TUS-CPS). Results: Overall modeled prevalence of menthol cigarette use was similar to TUS-CPS estimates. Prevalence among adults who smoke increased in each division from 2002 to 2020. By 2020, prevalence was highest in the Middle (46.3%) and South Atlantic (42.7%) and lowest in the Pacific (25.9%) and Mountain (24.2%) divisions. Prevalence was higher among adults aged 18–29 (vs. 50+) and females (vs. males). Prevalence among non-Hispanic Black people exceeded 80% in the Middle Atlantic, East North Central, West North Central, and South Atlantic in all years and varied most among Hispanic people in 2020 (Pacific: 26.5%, New England: 55.1%). Conclusions: Significant geographic variation in the prevalence of menthol cigarette use among adults who smoke suggests the proposed US Food and Drug Administration (FDA) menthol cigarette ban will exert differential public health benefits and challenges across geographic and demographic subgroups. [ABSTRACT FROM AUTHOR]

The twenty-first century has seen near constant crises and conflicts across the Middle East, many of which have had a devastating impact on the region's rich cultural heritage. Confronted by this reality, UNESCO – the world's foremost body designed to promote the protection of heritage – has struggled to meaningfully address site destruction and has been hamstrung by its own institutional inertia. The vacuum created by UNESCO's failures has given rise to a hybrid heritage landscape of multilateral agencies, INGOs, state bodies and local organisations which seek to emulate, improve on or radically re-imagine the work that UNESCO was designed to lead. In turn, this has created burgeoning business opportunities and a thriving consultancy culture for INGOs, often with little public oversight, accountability or effective monitoring. This paper critically examines the rise of these heritage INGOs and their efforts in the Middle East, bringing into question their efficacy and legitimacy by drawing on results from original surveys conducted in both Mosul and Aleppo. The results indicate that these heritage INGOs largely fail to adequately engage locals in their programmes to protect and restore heritage and that respondents would prefer to see domestic control over the future of their past. [ABSTRACT FROM AUTHOR]

Science journalism associations at a national and international level have aimed to form networks of support for the professionalization of the field. In this article, we focus at the process of consolidation of one of the first of such international organizations: the Ibero-American Association of Science Journalism (AIPC), created in Medellín in 1969, which sowed the seeds for the creation of new national associations across Latin America and connected these national organizations in Latin America and Spain through international conferences, exchange programs, and training initiatives. Through the analysis of historical documentation from the personal archive of one of its main leaders, the Spanish Manuel Calvo Hernando, we explore the dynamic between the AIPC and the national associations in Latin America during this formative period. [ABSTRACT FROM AUTHOR]

This article explores mental health struggles experienced by international adoptees. A series of 26 qualitative retrospective interviews with international adoptees in Norway, aged 21–34 at the time of interview, shows how a considerable number of these adoptees experienced profound mental health issues, particularly depressive symptoms. The findings suggest that struggles relating to mental health are strongly associated with the challenge of constructing a sense of identity, the lack of a sense of belonging, and grieving for adoption-related losses. The adoptees with these struggles also tended to lack narrative agency—the ability and opportunity to change and influence one's own life course. This research has implications for policy and practice in the sense that adoptees' self-reports of mental health struggles, and their link to adoption-specific issues of identity and belonging, demonstrate the need for post-adoption services tailored to supporting adoptees in the construction of a secure sense of identity and belonging. Post-adoption support can help to reduce the risk of rumination over adoption-related questions in solitude and, as such, contribute to protecting the mental health of adoptees. [ABSTRACT FROM AUTHOR]

Cyprus is a nation of great history, old and new, that makes up a controversial and often stressful environment in which social work is practiced. The intent of this paper is to highlight the Cypriot context and discuss how the Global Agenda is integrated in it. Drawing on the key objectives of the Global Agenda — promoting social and economic equalities; promoting the dignity and worth of peoples; promoting community and environmental sustainability; and, strengthening recognition of the importance of human relationships — the paper explores the challenges and barriers that social work in the nation faces in an attempt to promote the wellbeing and growth of communities, families and individuals. With consideration to the many and rich initiatives toward increasing social solidarity, collaboration and community engagement, the paper makes suggestions to overcome the challenges that prevent social work from fully committing to the agenda. [ABSTRACT FROM AUTHOR]

Background: Stem cell‐based therapy (SCT) is an important component of regenerative therapy that brings hope to many patients. After decades of development, SCT has made significant progress in the research of various diseases, and the market size has also expanded significantly. The transition of SCT from small‐scale, customized experiments to routine clinical practice requires the assistance of standards. Many countries and international organizations around the world have developed corresponding SCT standards, which have effectively promoted the further development of the SCT industry. Methods: We conducted a comprehensive literature review to introduce the clinical application progress of SCT and focus on the development status of SCT standardization. Results: We first briefly introduced the types and characteristics of stem cells, and summarized the current clinical application and market development of SCT. Subsequently, we focused on the development status of SCT‐related standards as of now from three levels: the International Organization for Standardization (ISO), important international organizations, and national organizations. Finally, we provided perspectives and conclusions on the significance and challenges of SCT standardization. Conclusions: Standardization plays an important role in the sustained, rapid and healthy development of SCT. [ABSTRACT FROM AUTHOR]

International institutions such as UNESCO are deliberating on a new standard setting instrument for neurotechnologies. This will likely lead to the adoption of a soft law document which will be the first global document specifically tailored to neurotechnologies, setting the tone for further international or domestic regulations. While some stakeholders have been consulted, these developments have so far evaded the broader attention of the neuroscience, neurotech, and neuroethics communities. To initiate a broader debate, this target article puts to discussion twenty-five considerations and desiderata for recognition by a future instrument. They are formulated at different levels of abstraction, from the big picture to technical details, seek to widen the perspective of preparatory reports and transcend the narrow debate about "neurorights" which overshadows many richer and more relevant aspects. These desiderata are not an exhaustive enumeration but a starting point for discussions about what deserves and what requires protection by an international instrument. [ABSTRACT FROM AUTHOR]

Objective To quantify the association between reduction in child mortality and routine immunization across 204 countries and territories from 1990 to 2019. Methods We used child mortality and vaccine coverage data from the Global Burden of Disease Study. We used a modified child survival framework and applied a mixed-effects regression model to estimate the reduction in deaths in children younger than 5 years associated with eight vaccines. Findings Between 1990 and 2019, the diphtheria--tetanus--pertussis (DTP), measles, rotavirus and Haemophilus influenzae type b vaccines were significantly associated with an estimated 86.9 (95% confidence interval, CI: 57.2 to 132.4) million fewer deaths in children younger than 5 years worldwide. This decrease represented a 24.2% (95% CI: 19.8 to 28.9) reduction in deaths relative to a scenario without vaccines. The DTP and measles vaccines averted 46.7 (95% CI: 30.0 to 72.7) million and 37.9 (95% CI: 25.4 to 56.8) million deaths, respectively. Of the total reduction in child mortality associated with vaccines, 84.2% (95% CI: 83.0 to 85.1) occurred in 73 countries supported by Gavi, the Vaccine Alliance, with an estimated 45.4 (95% CI: 29.8 to 69.2) million fewer deaths from 2000 to 2019. The largest reductions in deaths associated with these four vaccines were in India, China, Ethiopia, Pakistan and Bangladesh (in order of the size of reduction). Conclusion Vaccines continue to reduce childhood mortality significantly, especially in Gavi-supported countries, emphasizing the need for increased investment in routine immunization programmes. [ABSTRACT FROM AUTHOR]

The article offers information on the International Children's Advisory Network (iCAN) and its dedication to empowering pediatric patients worldwide. Topics include iCAN's commitment to facilitating active participation of pediatric patients in innovation, research, and medicine, as well as a recent series featuring guest speaker Mary Jenner, RN, who shared her journey from author to entrepreneur in empowering young patients through healthcare innovation.

The exercise of public power by substate entities poses a challenge for international law. Although such entities lack international legal personality, their actions can have international significance and, because they are state organs, must always adhere to the international obligations assumed by the state. In Spain, the autonomous communities exercise broad powers, which, in the case of Catalonia (via the Generalitat), include education, healthcare, prisons and police. Research shows that the Generalitat has exercised – and, to some extent, continues to exercise – some of its powers in disregard of certain constitutional and legal obligations. This action by public authorities in disregard of the law can have international consequences, and various international organizations have expressed positions on it through their bodies. This paper examines these positions on the Generalitat's actions in connection with the secession process and other related policies, including both those that have been critical of this behaviour and those that have expressed direct or indirect support for it. The practice of the European Union, the Council of Europe, and the UN Human Rights Council through its Special Rapporteur on minority issues is analysed. [ABSTRACT FROM AUTHOR]

Motivation Motivated by the challenges of decentralized genetic data spread across multiple international organizations, GINSA leverages the Global Biodiversity Information Facility infrastructure to automatically retrieve and link small ribosomal subunit sequences with locality information. Results Testing on taxa from major organism groups demonstrates broad applicability across taxonomic levels and dataset sizes. Availability and implementation GINSA is a freely accessible Python program under the MIT License and can be installed from PyPI via pip. [ABSTRACT FROM AUTHOR]

This paper opens a critical conversation about the ethics of international bioethics conferencing and proposes principles that commit to being anti-discriminatory, global, and inclusive. We launch this conversation in the Section, Case Study, with a case example involving the International Association of Bioethics' (IAB's) selection of Qatar to host the 2024 World Congress of Bioethics. IAB's choice of Qatar sparked controversy. We believe it also may reveal deeper issues of Islamophobia in bioethics. The Section, Principles for International Bioethics Conferencing, sets forth and defends proposed principles for international bioethics conferencing. The Section, Applying Principles to Site Selection applies the proposed principles to the case example. The Section, Applying Principles Beyond Site Selection addresses other applications of the proposed principles. The Section, Objections responds to objections. We close (in the Section, Conclusion) by calling for a wider discussion of our proposed principles. One-Sentence Capsule Summary: How should bioethicists navigate the ethics of global bioethics conferencing? [ABSTRACT FROM AUTHOR]

The article presents the discussion on current presidents of the International Association of Bioethics and by some of its board members. Topics include principles for organizing and hosting ethics conferences as presented in the target article; and expanding the debate with new open-minded insights from a broader circle of bioethicists.

Fourth World knowledge systems vary widely but in the contemporary international environment, nations may be seen as engaging neighboring nations, states and international institutions with differing capacities. Understanding the different diplomatic capacities and levels of knowledge is critical to the process of implementing the UN Declaration on the Rights of Indigenous Peoples (UNDRIP). Mechanisms for implementing the UNDRIP must be nationspecific and state-specific and agreeable to both sides. Forty or more years after "indigenous rights" was sounded as a human rights goal, and indigenous nations are now obliged to take diplomatic initiatives employing their history of diplomatic experience. [ABSTRACT FROM AUTHOR]

In OECD country members, education policies tend to cut back funding and instructional time for music education at schools, even when supranational agencies advocate for universal access to music involvement and learning. The current study aims to explore music education inequities from the Chilean school system. The method is centered on multiple-case study design, focusing on three boundaries: the time, space, and place. The sample, which was chosen by criteria linked to maximum variation sampling, included participation from 30 music teachers. Results suggest that discrepancies in equitable opportunities are caused not only by the economic situation of schools, but are also provoked by Chile's centralized educational model. In conclusion, some educators live on a darker side than others, but all music teachers are able to see the sun daily because they overcome inequities. Some implications are proposed. [ABSTRACT FROM AUTHOR]

Iodine deficiency and excessive salt intake have adverse health effects. This study evaluated the iodine level and salt intake in Chinese adults aged 18–59 years after implementing the salt reduction program and compared with both the World Health Organization (WHO) and Chinese recommendations. Adults aged 18–59 years were randomly selected using multi-stage stratified random sampling in coastal urban area (CUA), non-coastal urban area (Non-CUA), coastal rural area (CRA), and non-coastal rural area (Non-CRA) of Fujian Province, China. Iodine, sodium, and creatinine concentrations in spot urine samples were measured. Knudsen equation was used to determine 24-h urinary iodine and sodium excretion. The median urinary iodine concentration (mUIC) and urinary sodium concentration (mUNaC) among adults (n = 3513) were 132.0 μg/L and 4.0 g/d, respectively. The mUIC and median daily iodine intake in CUA, Non-CUA, CRA and Non-CRA were 112.1, 127.5, 128.5, 167.5 μg/L and 189.6, 182.5, 199.4, 236.0 μg/d, respectively. The mUNaC and median daily salt intake (mDSI) in these four areas were 2.4, 2.8, 2.9, 2.9 g/L and 9.8, 10.4, 10.4, 10.6 g/d, respectively. The mUIC and DII of residents were higher in the Non-CRA than in the other three areas (P < 0.05). The UNaC and DSI of residents were lower in the CUA than in the other three areas (P < 0.05). The logistic regression demonstrated that the people living in CUA and Non-CUA consumed less salt compared with those in Non-CRA. Except for Non-CUA, the DII was lower (< 150 μg/d) among women of childbearing age in the low–salt intake group (< 5 g/d) compared with the high–salt intake group (≥ 5 g/d) (P < 0.05). Iodine nutrition in Chinese adults aged 18–59 years was sufficient, but the salt intake was substantially higher than the WHO and Chinese recommendations. Further policy implementation is needed to reduce salt intake and improve the monitoring of iodine levels in Chinese adults, especially in women of childbearing age. [ABSTRACT FROM AUTHOR]

The article focuses on the bilateral relations between Mexico and New Zealand, highlighting diplomatic insights provided by Mexico's ambassador to New Zealand, HE Alfredo Pérez Bravo. Topics discussed include the 50th anniversary of diplomatic ties, collaboration in trade and economic sectors, and initiatives for cultural exchange and academic cooperation.